Kidney Transplantation in Children: The Preferred Option But Still No Cure

The paper from White and colleagues1 in this issue of AJKD, based upon data from a single center in British Columbia, Canada, is a timely reminder to clinicians caring for children with chronic kidney disease (CKD),2 that kidney transplantation only means a different stage (CKD-T) and not complete cure from CKD. In children, as in adults, transplantation provides substantially improved quality of life compared with dialysis, reduces the hazard of death by about 70%, and is clearly the optimal mode of renal replacement therapy.3, 4, 5 However, it is not a panacea, it does not remove the CKD state, and mortality for transplanted children remains substantially higher than children who do not have CKD.3 Causes of death are primarily cardiovascular but increased cancer and infection risk are also contributory.3, 6 This paper shows that although this case series of kidney transplant recipients have good kidney function (median glomerular filtration rate of 76 mL/min/1.73 m2), anemia and hypertension, known risk factors for adverse cardiovascular outcomes, occur commonly in this group of children.